Monday, October 15, 2007

National Health or Individual Well-Being?

The Telegraph has another horror story about Britain’s National Health Service:

People with toothache are resorting to pulling their own teeth because they cannot find a NHS dentist, a study out today says.

Almost a fifth of those questioned in the biggest patient survey of its kind said that they had missed out on dental work because of the cost.

The research, involving more than 5,000 patients in England, also found that as many as six per cent had treated themselves because they could not find a dentist.

Some said they took out their own teeth or fixed broken crowns with glue. One person in Lancashire had carried out 14 separate extractions with pliers.

A researcher at a shopping centre in Liverpool met three separate people in one morning who had pulled out teeth themselves.

Almost three fifths (58 per cent) of dentists said new contracts brought in last year had made the quality of care worse and 84 per cent thought the changes had failed to make it easier for patients to get an appointment.


Sharon Grant, chair of the Commission for Patient and Public Involvement in Health, which set up the forums, said the results from patients and doctors indicated “serious failings” in the NHS dental system.

“It appears many patients are being forced to go private because they don’t want to lose their current trusted and respected dentist or because they just can’t find a local NHS dentist,” she said.

“There are real policy issues here that have been fudged for too long. Is NHS dentistry just for those who can’t afford anything else - or can it revert to a universal, affordable, service to which people have entitlement as citizens and tax- payers?

In the U.S., many people have dental insurance, but a great number do not. And the price of dental care here is quite high, though many dentists are willing to work out a payment plan for those without insurance.

Part of the problem here is a difference in attitude between socio-economic groups regarding the definitions of luxuries and necessities. I have helped poor people get emergency dental care because they were in pain with abscessed teeth. On the other hand, the economic choices I see many people make often preclude dental care.

They buy expensive cars, for example. One person I helped (because she was in pain) has a 2006 car and her payments cost $250.00 a month - not to mention the tax bill on such a new car, or the insurance premiums. She lost her job unexpectedly and is now stuck with this albatross - and then a few weeks ago was struck with a badly abscessed tooth. There is no room now in her life for any emergencies. And just when she thought things were at their worst, she hit a deer with her car and can't afford the deductible it will require to have the car fixed even when her insurance company does pay up.

I have seen poor parents pay over $100.00 or more for sneakers for their children, yet would balk at the $85.00 it would take to have the same child’s teeth cleaned. For that matter, so would the child balk at parents making such a choice. The shame of wearing no-name shoes simply can’t be borne but dental care is a “luxury.”
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The homes of those among the urban poor whose income would be considered “poverty level” always have expensive media equipment. Big TVs, DVD players and the DVDs to go with them, games, cameras, etc., are often in evidence. They also spend a great deal of money on fast food and pizza delivery. These people don’t have dentists on the radar until the pain starts, and then it is simply to get rid of the offending tooth rather than having regularly scheduled appointments for prevention and treatment.

In the end, it comes down to what we consider important. Will it be bread and circuses now or regular dental care and savings for old age? The statement from the bureaucrat quoted above - i.e., is dental care “a universal, affordable, service to which people have entitlement as citizens and tax- payers?” - strikes me as the epitome of what’s wrong with socialized medicine. Entitlements of any sort ruin what is best about human beings: their strivings for liberty. Entitlements breed resentment and envy. They are never enough and no government could raise enough taxes to offset the death of enterprise and striving that comes with making one’s own way in the world.

In fact, I would hazard a guess that the number of dentists per capita in Britain has probably declined since the onset of the systemic illness known as the NHS.

I pray that the US can avoid that particularly rabid affliction, one which the Democrats are anxious to bestow upon us, using our money -- while they studiously avoid discussing the damage and side-effects such a disease would impose upon the body politic.

And if we do get socialized medicine imposed on us, where ever will the Canadians go for high risk premature babies?


rickl said...

And if we do get socialized medicine imposed on us, where ever will the Canadians go for high risk premature babies?

That's what I can't figure out. Right now the U.S. is where elites from all over the world go to get decent medical care. What will they do when the U.S.--and the whole world--has socialized medicine?

I mean, they obviously have no intention of living by the same rules they impose on us peasants. They must have something up their sleeves.

xlbrl said...

Ya, Dymphna. Cell phones before so many people had them, the best in tv's, sound equipment, cable, clothes, and yes, cars. And
these are the poor people. My brother dated black women for years. The ones making $10 an hour lived better than he did. Medical is taken care of, period. Nice. Not dental, true, but Hillary will fix that inequity.
My dentist set up a program to help the indigent and the very poor (generally white or Mexican) two Saturdays a month. He gave it up. No shows, ingatitude, and small horrors got him off his charitable kick.
I have no insurance and pay in cash. So I'd told him I was taking 10% off my bill since I figured I was paying for his charity. Now I don't get to do that.

Vol-in-Law said...

The NHS is pretty crap, but having socialised medicine doesn't mean there's no private medicine. Here in the UK, the wealthy elites talk about how great the NHS is, but get most of their own medical care privately. I expect the same would happen in the USA.

The big advantage of the NHS compared to the USA is that people who are injured or otherwise need emergency treatment don't get lumbered with huge bills. The injuries of the kid beaten up by the Jena 6 incurred a $12,000 ER bill for his parents. To me that's immoral. Generally speaking the NHS works pretty well for emergency care, the US system works better for treating longer terms illnesses like cancer, at least if you have good insurance. But Brits could buy private insurance too, and cheaper than in the USA.

Linda Fox said...

It's just one more example of the ant and the grasshopper. The grasshoppers can out-vote us ants. Worse, the grasshoppers will take the money from the grasshoppers who have done without, all because they are hopelessly improvident.

I posted about the same on:

History Snark said...

Two thoughts here: First, I just reread an old Mark Steyn article on Canada's "health care" system. Charming tale of his wife sitting in the emergency room reading (and finishing) a 300+ page novel while bleeding from a miscarriage.

Secondly, the comment on people in the ghetto having expensive toys in their house rings true, as anyone that's ever worked in that environment knows. I worked for a while at a small rental company, which had a lot of properties in our mid-sized but economically screwed community. Among my coworkers, it was a truism that the bigger the television set, the faster the tenants would be evicted.

A couple times, a woman would get away from an abusive relationship, and find an apartment for her kids and herself. And then run right out to the local store and buy a 52 inch flatscreen TV (on credit of course).

But it isn't a new problem. Different toys, but my dad has told me tales of seeing the same attitude back in the 30s and 40s.

Carnivorous Beaver said...

In Ontario Canada, where I live, there are plenty of dentists. They are private. But there is a severe shortage of General Practitioners. They are covered by our public health system.

It's very simple: socialism leaches the value out (my last GP retired after years without any vacations; he had bought his practice about 20 years ago, but he couldn't sell it) and destroys supply. As the experience of any Eastern European country shows.

We have dentists because they are still private; the UK does not. We (and the UK) have a shortage of physicians because they are socialised.

Dymphna said...


You're entitled to your opinion, and you have the right to be mystified about the subject.

Ain't entitlements grand??


My dentist does his charity work on referrals from other people. That usually works. Also, he spends two weeks a year in either India of Eastern Europe, treating patients and teaching local
dentists new techniques. These are techniques that American dentists pay good money to learn from him.
vol-in-law --

I don't know that story about the beating. However, if it happened in the US and the parents have a mid-to-low income (it doesn't have to be poverty level), then they are entitled to free care for their chldren up to age 18. That's how Congress is getting its toe in the door of socialized medicine -- "it's for the children."

12,000.00 is outrageous. Look at your insurance claims sometime: note that your charges are heavily deducted because the hospitals have had to agree to pay "usual and customary" fees for those with insurance. Insurance companies won't put up with hospitals' chicanery. Sometimes the fee is routinely reduced by as much as 60%...meanwhile those w/o insurance are charged the whole thing. A Chicago newspaper complained that Obama's wife sits on the board of directors of a large hospital in the city and has done nothing about the situation for poor folks in her area. The non-profit hospital actually has a surplus, too. IOW, they're making a profit.

Hospital billing will take you to court. When I used to attend court with clients, there would be a whole session devoted just to University hospital bills. Considering the amount of money that flows into that place, it's disgusting that they charge the poor.

Also, if it's still in effect, the Hill-Burton Act of some years ago required that any hospital receiving federal money had to treat indigent emergency patients for no charge.

IOW there are ways around this if people are aware of them.

A relative of mine was without insurance briefly and she took her newborn in for a check-up. The fee was high, so she asked if they would reduce it if she paid cash. No go. So she asked to speak to the doctor (annoyed the heck out of the billing person). She explained her situation to the doctor and he simply wrote "NO FEE" on her bill. It pays to ask.

On occasion I have run into an incompetent doctor who fails to prescribe the correct treatment and when their bill comes after the insurance is paid, I write back and tell them I am not paying the remainder and why. I have yet to be dunned for far.

I'm sending one out today to an orthopedic surgeon who was recommended by the ER when I tore my rotator cuff. He gave me instructions for rehab, but never requested an MRI. Had I gone to physical therapy, I could have done further damage. Fortunately, I went to my chiropractor for pain management and he took one look at my shoulder and called an orthopedist he trusted to make an immediate appointment. They did an MRI, found a "massive" tear, and did the surgery quickly. My insurance has no limits on PT for that kind of severe diagnosis since it takes so long to get your mobility back.

The first doc just sent me his bill and I'm not paying it. It was incompetent/careless -- whatever -- not to get an MRI first. The competent doc would not permit *any* PT until a month after the surgery...and it was two months before I moved beyond very mild arm circles.

Medical practices in the US have been patched together since WWII. While it's time for an overhaul, those countries with socialized medicine have shown us that it doesn't work very well. If it did, we wouldn't have so many Canadians coming across the border for treatments they can't get in Canada -- or can't get on a timely enough basis to be of help. Having to wait a year for a hip replacement is outrageous.

Dymphna said...

gun-totin-wacko --

Your experience is spot on. And no wonder Mark Steyn moved to the US.
carnivorous beaver --

You've described the issue as a market problem perfectly.

It's been my experience taht dentists are craftsmen and as such, they don't put on the mantle of doctorhood. They're businessmen and treat their practices accordingly.

xlbrl said...

Great thread. We are knocking on the door of understanding the solution, or failing that, continuing the destruction.
Liberty means responsibility. That is why some men dread it.
Those of us who are as jealous of our responsibilities as we are of our liberties have to figure out a method--not a system--of maintaining liberty in that environment, because when we play to the lowest common denominator, we all become it.
That is the object of the socialist. Equality.
I have had no health insurance for twenty-five years except major-medical with very high deductable. At the age of 60, I am paying $250 a month. That rate is several times higher in states where liberal mandates to "help" me rule, and I would not be doing this. I control all my other costs by speaking to doctors and dentist. Many respond very well. In fact, I would say eagerly. Not because they want my money, but because the entire system is de-humanizing to them even more than us.
I'm an early inventor of the Health Savings Account in practice, which works so well on so many levels that Keddy K. fought it tooth and nail.
When we KEEP health-care free, and make it more so, we strengthen and grow something. It is far more economical to pay for the irresponsible through welfare, and keep the engine of liberty growing, rather than reduce health-care to the stagnation of socialism, so that the irresponsible do not feel the stigma of welfare.
Any society that is not advancing is in decay.

ricpic said...

If people want to destroy themselves by pursuing toys in lieu of necessities, fine, let them. Who is it that said, "There is much ruin in a nation?" Well, there is. Always has been. Always will be. Why gnash ones teeth over it? If another man's mouth is rotting out because of idiot decisions he's made how is that any concern of mine? Only if he comes for my property (socialism) does his behavior concern me.
Even when women, with their concern for others, their bottomless compassion, create a situation in which socialism wins out everywhere and there is no escape from the State, even then I can be free. How? By knowing myself. By husbanding my resources, what is left of them, after paying tribute to the State. By not caring about, not listening to the idiot cacaphony of caring that surrounds me. By learning what to treasure... and what to throw out. Simplicity; Modesty; Integrity: Freedom.

Don Miguel said...

"If people want to destroy themselves by pursuing toys in lieu of necessities, fine, let them. Who is it that said, 'There is much ruin in a nation?' Well, there is. Always has been. Always will be. Why gnash ones teeth over it? If another man's mouth is rotting out because of idiot decisions he's made how is that any concern of mine? Only if he comes for my property (socialism) does his behavior concern me."

Unfortunately your last sentence is the key. For example, a good number of baby-boomers have saved nothing for retirement and another large percentage has saved too little. When they go on social security and find out that they have little or nothing else, where do you think they'll get their money from? It won't be from their children and grandchildren because they're not enough of them to support they system as it is now. They'll get it via the ballot box from the smaller percentage that saved enough to retire comfortably. Welcome to socialist redistribution of income and savings.

Nancy Ewart said...

Lots of interesting comments to your post. I'm probably more liberal than most of the posters but won't get into that now. However, in the US, the poor or those who can't afford dental care can get free or low cost dental care at dental schools. I used to work at a huge medical/university complex and the dental students there were always looking for new victims (er..subjects) to practice on. It could be quite an ordeal as a "normal" procedure that would take an hour at your dentist could take up to 4 or 5 hours if done by a student. However, in a lot of states, the rural poor don't have access to these huge medical/university school and also, don't have the money, easy credit or welfare benefits for the junk and toys that you describe. There's something valid for all points of view expressed in your blog but I'd rather come down on the side of compassion, esp. when it relates to children. After all, they can't be blamed if their parents spend money for electronic toys instead of health care.

Just a thought. Also, I really appreciate your blog. I read it constantly and wonder what the future of Europe will be if the trends that you worry about continue unchecked..

Larry Sheldon said...

Re: Dental clinics at Dental Schools.

Some Dental Schools take their show on the road--to rural areas, to foreign countries.

Dymphna said...


I worked as a lowly clerk in one of those University Medical school warrens and I depended on dental residents for my care. But they quit offering treatment in the late '80's. I have no idea where they get their practice patients now...

...perhaps the rural clinics you mention, since there is one about 25 miles from us that does offer dental care and transportation.

I followed one of those residents out when he graduated. Turned out to be an excellent practitioner (esp. crowns) and a wonderful human being. We're still friends all these years later.

He let me pay in small increments as I went along. Sometimes it would take a year to get a zero balance and then wham! another crown. I once told him I wanted to leave a $5.00 balance so I could avoid the next crown...

Dymphna said...

oh, BTW, namastenancy--

I went to your blog (y'all ought to see her work) and it reminded me that sometimes my dentist took the Baron's landscapes in return for dental work. The B paints in a kind of Pissaro/Japanese brush style. Or he did before this blog...but the exacting work dentists do has its own kind of artistry.

xlbrl said...

You have a point, supercop. That's why the socialist are winning, because we don't understand half the little things they are up to.
Then they roll into bigger things, and it's too late to stop them.
When we lose health-care to socialism, we are done.

ic said...

One of the reasons why dental care is so expensive is malpractice insurance premiums that dentists have to pay. For instance, a dentist has to pay premiums for year 2000 covering all the patients that he treated for that year. In year 2001, he has to pay premiums for those he treated in 2001, plus premiums on those he treated in 2000 in case they sued, and on and on. A dentist also has to spend time to file insurance claims, or hire an assistant to file such claims. The claims are different for different insurance companies, they may be different for different employers using the same insurance company.

Dymphna said...


You mean we should thank John Edwards for our high dental bills? No wonder there are two Americas...he helped draw the dividing line.

bernie said...

Just FYI, I linked to your post from Michael Moore overlooked this in Sicko

Beamers Creek Coffee Roasters said...

One difference between Canada and the UK. In the UK, you can seek private treatment and can buy private medical insurance. In Canada, we are prevented by law from doing either. Our elected officials seem to take absurd pride in the fact that we don't have "two tier medicine". Of course in reality we do, only the second tier means going to the US to pay out of pocket for prompt treatment. I waited 18 months to get a GP, and have never seen him for more than a 5 minute visit. My private dental care however, which is paid for by my employer's Blue Cross plan (90% coverage), is excellent. Blue Cross also covers eye care and perscription drugs, none of which are covered by our public system. Yet if you want to talk about private healthcare in Canada, people go berserk, and start shrieking about how the last thing we need is a "American style" system. Heck, I'd be happy for a Swedish style system, a German style system, or a French style system. All those countries have mixed public-private systems. *sigh*

spackle said...

Just a few thoughts on this old thread. I personally think Dentists are running one of the biggest scams going, at least here in the US. I have had minor surgeries that were cheaper than a couple of crowns. And dental insurance is a joke.

As to the global elites who come here for treatment it is very true. I had a family member who worked at Sloan Kettering Cancer in NYC. They have entire floors that are like the Waldorf Astoria for all the foreign elites. The irony here is that A LOT of them are Saudi princes and other royalty who wish us much harm. Hippocratic oath be dammed. I dont think I could do it.

Finally, in regards to poor people with big toys and hospital bills. I worked for an attorney for a hot minute who did collections for a hospital. My job was to go to different peoples homes and have them fill out the paperwork to apply for Medicaid to get the bill paid. Something they could have done had they simply gone to social services and applied. But alas most of them dont care. Life in a nanny state will always mean someone else will do your work for you.

Anyhow, on one particular day I had to visit a black woman who had a large hospital bill to fill out the paperwork. She lived in one of the nicer projects in the city. River views, rock bottom rent and fairly safe. Much nicer and cheaper then my place. When she opened the door she had me stand, STAND in the foyer while she went into another room with a '42 tv blaring. Five minutes went by, nothing, ten minutes, nothing. Finally I said "Miss". "wait" she said "just let me finish watching this". I couldnt believe it. I turned around and walked out. She chased after me saying she was sorry and was ready to fill out the papers, I just kept walking. That was when she let loose with the "white m**********r" remark. She then had the gall to call my office and complain about me. She finally found some other sucker to help her. That was it as far as "social work" goes for me.